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General NPI Number Information
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NPI Number | 1346912110
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Entity Type | Organization
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Legal Business Name | TRELLUS MEDICINE PC
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Dates
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Enumeration Date | 09/30/2021
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Last Update Date | 01/05/2022
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Provider Practice Location Address
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Address Line | 45 N BROAD ST
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3856
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Country | US
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Telephone | 800-989-5503
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Fax |
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Provider Business Mailing Address
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Address Line | 250 PEHLE AVE STE 200
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City | SADDLE BROOK
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State | NJ
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Zip | 07663-5835
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFER
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Name | ANDRES JIMENEZ
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Credential | MD
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Telephone | 214-679-1220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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